高碳酸血症对丙泊酚/瑞芬太尼静脉全麻下熵指数监测的影响

Influence of Hypercapnia on the Monitoring of Spectral Entropy during Intravenous General Anesthesia with Propofol/Remifentanil

目的观察丙泊酚/瑞芬太尼全身麻醉下行腹腔镜手术时高碳酸血症对患者麻醉深度及熵指数监测的影响。方法22例行妇科腹腔镜手术通过积极增加分钟通气量仍未能纠正高碳酸血症,需降低气腹压力进一步处理的病人,观察30min后按呼气末二氧化碳分压(PetCO2)进行分组,8例病人PetCO2波动于51～55mmHg,归为Ⅰ组;6例病人波动于46～50mmHg,归为Ⅱ组;8例病人波动于40～45mmHg,归为Ⅲ组。分别记录麻醉前(T1)、切皮后(T2)、CO2气腹30min(T3)、降低CO2腹压30min后(T4)、停止麻醉时(T5)、拔除气管导管时(T6)的RE、SE、MBP、HR值,并记录停止麻醉至拔除气管导管的时间(T5-6)。结果Ⅰ组病人T4和T5的RE、SE值均低于Ⅲ组(P<0.05);Ⅱ组RE、SE值各时间点与其他两组差异无统计学意义。Ⅰ组病人T4和T5RE、SE值低于T2和T3(P<0.05);Ⅰ组病人意识恢复时间T5-6长于Ⅱ组和Ⅲ组(P<0.05)。结论应用丙泊酚/瑞芬太尼在妇科腹腔镜手术时,CO2气腹造成的高碳酸血症可使熵指数下降和意识恢复时间延长,在麻醉中应予以重视。

Objective To evaluate the influence of hypercapnia on the monitoring of spectral entropy in patients undergoing laparoscopic surgery by intravenous general anesthesia with propofol/remifentanil. Method During laparoscopic surgery, 22 patients developed hypercapnia after positive pulmonary ventilation volume management. After lowering the pressure of pneumoperitoneum, the patients were observed for 30 minutes. The patients were then divided into 3 groups according to PetCO2. The PetCO2 in Group I （8 cases）, Group lI （6 cases） and Group III （8 cases） was 51-55, 46-50 and 40-45 mmHg, respectively. The values of RE, SE, MAP and HR were measured at the time before anesthesia （T1）, after skin incision （T2）, 30 min after the start of CO2 pneumoperitoneum （T3）, 30 rain after decreasing the pressure of pneumoperitoneum （T4）, the end of anesthesia （T5） and at the time of removal of tracheal catheters （T6）. The duration between the end of anesthesia to the removal of tracheal catheters （T5-6） was also recorded. Result For the group I patients, the values of RE and SE at T4 and T5 were significantly lower than the group III patients （P〈0.05）. The values of RE and SE at T4 and T5 were also lower than the values measured at T2 and rF3 （P〈0.05）. The values of RE and SE in group lI had no significant difference with group I and group III. The time for the recovery of consciousness of T5-T6 was longer than the group lI and III patients （P〈0.05）. Conclusion Hypercapnia CO2 pneumoperitoneum-induced hypercapnia may decrease the values of RE and SE in patients under intravenous general anesthesia with propofol/remifentanil. Attention should be paid to the values of SE and RE and also the duration of recovery of consciousness.